43 research outputs found

    Ibero-American Consensus on Low- and No-Calorie Sweeteners: Safety, Nutritional Aspects and Benefits in Food and Beverages

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    International scientific experts in food, nutrition, dietetics, endocrinology, physical activity, paediatrics, nursing, toxicology and public health met in Lisbon on 2-4 July 2017 to develop a Consensus on the use of low- and no-calorie sweeteners (LNCS) as substitutes for sugars and other caloric sweeteners. LNCS are food additives that are broadly used as sugar substitutes to sweeten foods and beverages with the addition of fewer or no calories. They are also used in medicines, health-care products, such as toothpaste, and food supplements. The goal of this Consensus was to provide a useful, evidence-based, point of reference to assist in efforts to reduce free sugars consumption in line with current international public health recommendations. Participating experts in the Lisbon Consensus analysed and evaluated the evidence in relation to the role of LNCS in food safety, their regulation and the nutritional and dietary aspects of their use in foods and beverages. The conclusions of this Consensus were: (1) LNCS are some of the most extensively evaluated dietary constituents, and their safety has been reviewed and confirmed by regulatory bodies globally including the World Health Organisation, the US Food and Drug Administration and the European Food Safety Authority; (2) Consumer education, which is based on the most robust scientific evidence and regulatory processes, on the use of products containing LNCS should be strengthened in a comprehensive and objective way; (3) The use of LNCS in weight reduction programmes that involve replacing caloric sweeteners with LNCS in the context of structured diet plans may favour sustainable weight reduction. Furthermore, their use in diabetes management programmes may contribute to a better glycaemic control in patients, albeit with modest results. LNCS also provide dental health benefits when used in place of free sugars; (4) It is proposed that foods and beverages with LNCS could be included in dietary guidelines as alternative options to products sweetened with free sugars; (5) Continued education of health professionals is required, since they are a key source of information on issues related to food and health for both the general population and patients. With this in mind, the publication of position statements and consensus documents in the academic literature are extremely desirable

    Educación y desarrollo personal

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    Esta obra, fruto de investigaciones teóricas y prácticas, señala los caminos privilegiados que conducen a la persona hacia la plenitud humana y la felicidad. El primero de ellos, la familia, escenario educativo por excelencia, puesto que en su seno se establecen los vínculos constitutivos de la personalidad: paternidad, maternidad y filiación; la familia es el lugar donde cada ser humano es reconocido y amado por sí mismo y aprende el buen ejercicio de su libertad. La escuela y la universidad constituyen el segundo espacio formativo de singular importancia; en este se ayuda a los jóvenes a desarrollar armónicamente la inteligencia, la voluntad y los afectos; lo anterior, a través de la educación formal –científica y humanística– y de aquellas actividades –como el voluntariado o el servicio social– que permiten la expresión de la compasión, la solidaridad, las cualidades artísticas, etc. Distintos ámbitos de desarrollo personal que apuntan a la consolidación de líderes virtuosos capaces de construir una cultura de la vida que camine hacia la paz.Prólogo. 1 · La familia, escuela de libertad para el desarrollo integral. 2 · Formación de la voluntad en jóvenes universitarios: realidad y claves educativas. 3 · Liderazgo virtuoso: un camino de plenitud personal. 4 · Experiencias de voluntariado como estrategia para fomentar habilidades emocionales en jóvenes universitarios. 5 · El amor como factor de desarrollo humano en la pareja. 6 · Hacia una cultura de paz desde el desarrollo humano y la universidad. 7 · El pathos cristiano, vía que conduce a una educación en la compasión. 8 · Estrategias de búsqueda, clasificación y verificación de la información en la web. 9 · Trabajo social y educación para el servicio. 10 · Formación del artista en la obra El arte como experiencia de John Dewey.1a

    Cut-offs and response criteria for the Hospital Universitario la Princesa Index (HUPI) and their comparison to widely-used indices of disease activity in rheumatoid arthritis

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    Objective To estimate cut-off points and to establish response criteria for the Hospital Universitario La Princesa Index (HUPI) in patients with chronic polyarthritis. Methods Two cohorts, one of early arthritis (Princesa Early Arthritis Register Longitudinal PEARL] study) and other of long-term rheumatoid arthritis (Estudio de la Morbilidad y Expresión Clínica de la Artritis Reumatoide EMECAR]) including altogether 1200 patients were used to determine cut-off values for remission, and for low, moderate and high activity through receiver operating curve (ROC) analysis. The areas under ROC (AUC) were compared to those of validated indexes (SDAI, CDAI, DAS28). ROC analysis was also applied to establish minimal and relevant clinical improvement for HUPI. Results The best cut-off points for HUPI are 2, 5 and 9, classifying RA activity as remission if =2, low disease activity if >2 and =5), moderate if >5 and <9 and high if =9. HUPI''s AUC to discriminate between low-moderate activity was 0.909 and between moderate-high activity 0.887. DAS28''s AUCs were 0.887 and 0.846, respectively; both indices had higher accuracy than SDAI (AUCs: 0.832 and 0.756) and CDAI (AUCs: 0.789 and 0.728). HUPI discriminates remission better than DAS28-ESR in early arthritis, but similarly to SDAI. The HUPI cut-off for minimal clinical improvement was established at 2 and for relevant clinical improvement at 4. Response criteria were established based on these cut-off values. Conclusions The cut-offs proposed for HUPI perform adequately in patients with either early or long term arthritis

    The comparative responsiveness of Hospital Universitario Princesa Index and other composite indices for assessing rheumatoid arthritis activity

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    Objective To evaluate the responsiveness in terms of correlation of the Hospital Universitario La Princesa Index (HUPI) comparatively to the traditional composite indices used to assess disease activity in rheumatoid arthritis (RA), and to compare the performance of HUPI-based response criteria with that of the EULAR response criteria. Methods Secondary data analysis from the following studies: ACT-RAY (clinical trial), PROAR (early RA cohort) and EMECAR (pre-biologic era long term RA cohort). Responsiveness was evaluated by: 1) comparing change from baseline (Delta) of HUPI with Delta in other scores by calculating correlation coefficients; 2) calculating standardised effect sizes. The accuracy of response by HUPI and by EULAR criteria was analyzed using linear regressions in which the dependent variable was change in global assessment by physician (Delta GDA-Phy). Results Delta HUPI correlation with change in all other indices ranged from 0.387 to 0.791); HUPI's standardized effect size was larger than those from the other indices in each database used. In ACT-RAY, depending on visit, between 65 and 80% of patients were equally classified by HUPI and EULAR response criteria. However, HUPI criteria were slightly more stringent, with higher percentage of patients classified as non-responder, especially at early visits. HUPI response criteria showed a slightly higher accuracy than EULAR response criteria when using Delta GDA-Phy as gold standard. Conclusion HUPI shows good responsiveness in terms of correlation in each studied scenario (clinical trial, early RA cohort, and established RA cohort). Response criteria by HUPI seem more stringent than EULAR''s

    Familial hypercholesterolaemia in children and adolescents from 48 countries: a cross-sectional study

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    Background Approximately 450 000 children are born with familial hypercholesterolaemia worldwide every year, yet only 2·1% of adults with familial hypercholesterolaemia were diagnosed before age 18 years via current diagnostic approaches, which are derived from observations in adults. We aimed to characterise children and adolescents with heterozygous familial hypercholesterolaemia (HeFH) and understand current approaches to the identification and management of familial hypercholesterolaemia to inform future public health strategies. Methods For this cross-sectional study, we assessed children and adolescents younger than 18 years with a clinical or genetic diagnosis of HeFH at the time of entry into the Familial Hypercholesterolaemia Studies Collaboration (FHSC) registry between Oct 1, 2015, and Jan 31, 2021. Data in the registry were collected from 55 regional or national registries in 48 countries. Diagnoses relying on self-reported history of familial hypercholesterolaemia and suspected secondary hypercholesterolaemia were excluded from the registry; people with untreated LDL cholesterol (LDL-C) of at least 13·0 mmol/L were excluded from this study. Data were assessed overall and by WHO region, World Bank country income status, age, diagnostic criteria, and index-case status. The main outcome of this study was to assess current identification and management of children and adolescents with familial hypercholesterolaemia. Findings Of 63 093 individuals in the FHSC registry, 11 848 (18·8%) were children or adolescents younger than 18 years with HeFH and were included in this study; 5756 (50·2%) of 11 476 included individuals were female and 5720 (49·8%) were male. Sex data were missing for 372 (3·1%) of 11 848 individuals. Median age at registry entry was 9·6 years (IQR 5·8–13·2). 10 099 (89·9%) of 11 235 included individuals had a final genetically confirmed diagnosis of familial hypercholesterolaemia and 1136 (10·1%) had a clinical diagnosis. Genetically confirmed diagnosis data or clinical diagnosis data were missing for 613 (5·2%) of 11 848 individuals. Genetic diagnosis was more common in children and adolescents from high-income countries (9427 [92·4%] of 10 202) than in children and adolescents from non-high-income countries (199 [48·0%] of 415). 3414 (31·6%) of 10 804 children or adolescents were index cases. Familial-hypercholesterolaemia-related physical signs, cardiovascular risk factors, and cardiovascular disease were uncommon, but were more common in non-high-income countries. 7557 (72·4%) of 10 428 included children or adolescents were not taking lipid-lowering medication (LLM) and had a median LDL-C of 5·00 mmol/L (IQR 4·05–6·08). Compared with genetic diagnosis, the use of unadapted clinical criteria intended for use in adults and reliant on more extreme phenotypes could result in 50–75% of children and adolescents with familial hypercholesterolaemia not being identified. Interpretation Clinical characteristics observed in adults with familial hypercholesterolaemia are uncommon in children and adolescents with familial hypercholesterolaemia, hence detection in this age group relies on measurement of LDL-C and genetic confirmation. Where genetic testing is unavailable, increased availability and use of LDL-C measurements in the first few years of life could help reduce the current gap between prevalence and detection, enabling increased use of combination LLM to reach recommended LDL-C targets early in life. Funding Pfizer, Amgen, Merck Sharp & Dohme, Sanofi–Aventis, Daiichi Sankyo, and Regeneron

    Familial hypercholesterolaemia in children and adolescents from 48 countries: a cross-sectional study

    Get PDF
    Background: Approximately 450 000 children are born with familial hypercholesterolaemia worldwide every year, yet only 2·1% of adults with familial hypercholesterolaemia were diagnosed before age 18 years via current diagnostic approaches, which are derived from observations in adults. We aimed to characterise children and adolescents with heterozygous familial hypercholesterolaemia (HeFH) and understand current approaches to the identification and management of familial hypercholesterolaemia to inform future public health strategies. Methods: For this cross-sectional study, we assessed children and adolescents younger than 18 years with a clinical or genetic diagnosis of HeFH at the time of entry into the Familial Hypercholesterolaemia Studies Collaboration (FHSC) registry between Oct 1, 2015, and Jan 31, 2021. Data in the registry were collected from 55 regional or national registries in 48 countries. Diagnoses relying on self-reported history of familial hypercholesterolaemia and suspected secondary hypercholesterolaemia were excluded from the registry; people with untreated LDL cholesterol (LDL-C) of at least 13·0 mmol/L were excluded from this study. Data were assessed overall and by WHO region, World Bank country income status, age, diagnostic criteria, and index-case status. The main outcome of this study was to assess current identification and management of children and adolescents with familial hypercholesterolaemia. Findings: Of 63 093 individuals in the FHSC registry, 11 848 (18·8%) were children or adolescents younger than 18 years with HeFH and were included in this study; 5756 (50·2%) of 11 476 included individuals were female and 5720 (49·8%) were male. Sex data were missing for 372 (3·1%) of 11 848 individuals. Median age at registry entry was 9·6 years (IQR 5·8-13·2). 10 099 (89·9%) of 11 235 included individuals had a final genetically confirmed diagnosis of familial hypercholesterolaemia and 1136 (10·1%) had a clinical diagnosis. Genetically confirmed diagnosis data or clinical diagnosis data were missing for 613 (5·2%) of 11 848 individuals. Genetic diagnosis was more common in children and adolescents from high-income countries (9427 [92·4%] of 10 202) than in children and adolescents from non-high-income countries (199 [48·0%] of 415). 3414 (31·6%) of 10 804 children or adolescents were index cases. Familial-hypercholesterolaemia-related physical signs, cardiovascular risk factors, and cardiovascular disease were uncommon, but were more common in non-high-income countries. 7557 (72·4%) of 10 428 included children or adolescents were not taking lipid-lowering medication (LLM) and had a median LDL-C of 5·00 mmol/L (IQR 4·05-6·08). Compared with genetic diagnosis, the use of unadapted clinical criteria intended for use in adults and reliant on more extreme phenotypes could result in 50-75% of children and adolescents with familial hypercholesterolaemia not being identified. Interpretation: Clinical characteristics observed in adults with familial hypercholesterolaemia are uncommon in children and adolescents with familial hypercholesterolaemia, hence detection in this age group relies on measurement of LDL-C and genetic confirmation. Where genetic testing is unavailable, increased availability and use of LDL-C measurements in the first few years of life could help reduce the current gap between prevalence and detection, enabling increased use of combination LLM to reach recommended LDL-C targets early in life

    Ibero-American Consensus on Low- and No-Calorie Sweeteners : Safety, Nutritional Aspects and Benefits in Food and Beverages

    Get PDF
    International scientific experts in food, nutrition, dietetics, endocrinology, physical activity, paediatrics, nursing, toxicology and public health met in Lisbon on 2\u207b4 July 2017 to develop a Consensus on the use of low- and no-calorie sweeteners (LNCS) as substitutes for sugars and other caloric sweeteners. LNCS are food additives that are broadly used as sugar substitutes to sweeten foods and beverages with the addition of fewer or no calories. They are also used in medicines, health-care products, such as toothpaste, and food supplements. The goal of this Consensus was to provide a useful, evidence-based, point of reference to assist in efforts to reduce free sugars consumption in line with current international public health recommendations. Participating experts in the Lisbon Consensus analysed and evaluated the evidence in relation to the role of LNCS in food safety, their regulation and the nutritional and dietary aspects of their use in foods and beverages. The conclusions of this Consensus were: (1) LNCS are some of the most extensively evaluated dietary constituents, and their safety has been reviewed and confirmed by regulatory bodies globally including the World Health Organisation, the US Food and Drug Administration and the European Food Safety Authority; (2) Consumer education, which is based on the most robust scientific evidence and regulatory processes, on the use of products containing LNCS should be strengthened in a comprehensive and objective way; (3) The use of LNCS in weight reduction programmes that involve replacing caloric sweeteners with LNCS in the context of structured diet plans may favour sustainable weight reduction. Furthermore, their use in diabetes management programmes may contribute to a better glycaemic control in patients, albeit with modest results. LNCS also provide dental health benefits when used in place of free sugars; (4) It is proposed that foods and beverages with LNCS could be included in dietary guidelines as alternative options to products sweetened with free sugars; (5) Continued education of health professionals is required, since they are a key source of information on issues related to food and health for both the general population and patients. With this in mind, the publication of position statements and consensus documents in the academic literature are extremely desirable

    Manifestaciones Neurológicas en Hipernatremia.

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    Functional diversity In an altitudinal gradient of the complex of Páramos Sumapaz - Green Cross

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    Se establecieron cuatro transectos en diferentes locaciones alrededor del complejo de páramos Sumapáz – Cruz Verde con el fin de estudiar su ecología funcional a partir de la caracterización de tipos funcionales de plantas (TFP) que pertenecieran a los mismos. Lo anterior a través del establecimiento de siete estaciones a lo largo de un gradiente altitudinal de 700 metros, donde se establecieron en total tres parcelas por estación y 21 parcelas por transecto, cuyo tamaño varió dependiendo del tipo de ecosistema estudiado. Para la caracterización de estos tipos funcionales se tuvieron en cuenta cinco rasgos (AF, AFE, CFMSH, DM y HMAX), encontrando la consolidación de cuatro TFP que varían en cuanto a su representatividad a lo largo del gradiente dependiendo de la estrategia adaptativa de las especies que los componen. Estos TFP agrupan 96 especies distribuidas en 53 géneros y 30 familias, se resalta la importancia de los TFP 2 y 3 presentes en la denominada zona de transición entre bosque alto andino y páramo, aportando insumos no solo en la planeación de líneas de investigación que contribuyan al análisis de estrategias adaptativas de las especies ante el cambio climático en ecosistemas de alta montaña, sino también, en exaltar la importancia que tiene dicha zona de transición en las dinámicas poblacionales del entorno.Four transects were established in different locations around the complex moors Sumapaz - Green Cross in order to study the functional ecology from the characterization of plant functional types (TFP) that belong to them. This through the establishment of seven stations along an elevational gradient of 700 meters, where they established a total of three plots per station and 21 plots per transect, whose size varied depending on the studied ecosystem. For characterization of these functional types were considered five traits (AF, AFE, CFMSH, DM and HMAX), finding the consolidation of four TFP that vary in their representativeness along the gradient depending on the adaptive strategy of component species. TFP grouped these 96 species distributed in 53 genera and 30 families, the importance of TFP 2 and 3 present in the so-called transition zone between high Andean forest and paramo is highlighted, providing inputs not only in the planning of research lines that contribute analysis of adaptive strategies of the species to climate change in high mountain ecosystems, but also to exalt the importance of this transition zone in the population dynamics of the environment.Instituto de investigaciones biológicas Alexander von Humbold

    Functional Diversity In An Altitudinal Gradient Of The Complex Of Páramos Sumapáz - Green Cross

    No full text
    Se establecieron cuatro transectos en diferentes locaciones alrededor del complejo de páramos Sumapáz – Cruz Verde con el fin de estudiar su ecología funcional a partir de la caracterización de tipos funcionales de plantas (TFP) que pertenecieran a los mismos. Lo anterior a través del establecimiento de siete estaciones a lo largo de un gradiente altitudinal de 700 metros, donde se establecieron en total tres parcelas por estación y 21 parcelas por transecto, cuyo tamaño varió dependiendo del tipo de ecosistema estudiado. Para la caracterización de estos tipos funcionales se tuvieron en cuenta cinco rasgos (AF, AFE, CFMSH, DM y HMAX), encontrando la consolidación de cuatro TFP que varían en cuanto a su representatividad a lo largo del gradiente dependiendo de la estrategia adaptativa de las especies que los componen. Estos TFP agrupan 96 especies distribuidas en 53 géneros y 30 familias, se resalta la importancia de los TFP 2 y 3 presentes en la denominada zona de transición entre bosque alto andino y páramo, aportando insumos no solo en la planeación de líneas de investigación que contribuyan al análisis de estrategias adaptativas de las especies ante el cambio climático en ecosistemas de alta montaña, sino también, en exaltar la importancia que tiene dicha zona de transición en las dinámicas poblacionales del entorno.Four transects were established in different locations around the complex moors Sumapaz - Green Cross in order to study the functional ecology from the characterization of plant functional types (TFP) that belong to them. This through the establishment of seven stations along an elevational gradient of 700 meters, where they established a total of three plots per station and 21 plots per transect, whose size varied depending on the studied ecosystem. For characterization of these functional types were considered five traits (AF, AFE, CFMSH, DM and HMAX), finding the consolidation of four TFP that vary in their representativeness along the gradient depending on the adaptive strategy of component species. TFP grouped these 96 species distributed in 53 genera and 30 families, the importance of TFP 2 and 3 present in the so-called transition zone between high Andean forest and paramo is highlighted, providing inputs not only in the planning of research lines that contribute analysis of adaptive strategies of the species to climate change in high mountain ecosystems, but also to exalt the importance of this transition zone in the population dynamics of the environment.Instituto de investigaciones biológicas Alexander von Humbold
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